A case of anaphylactic shock to ethylenediaminetetraacetic acid as a drug excipient

ABSTRACT

If drug excipients hypersensitivity is not accurately recognized, the patient is at risk of experiencing repeated hypersensitivity to various drugs. Ethylenediaminetetraacetic acid (edetic acid, EDTA), often found as an excipient in injectable drugs and topical agents.Herein, we report a patient who developed anaphylactic shock to an injection containing EDTA and subsequently experienced both immediate and delayed hypersensitivity reactions to EDTA. A 51-year-old female was referred due to perioperative anaphylaxis. It took the patient 2 hours to return to the ward after receiving general anesthesia. Immediately after returning to the ward, the patient received injections of Mucosten (Medica), Traumeel (Saehan), and Botropase (Han Lim), and within 1 minute she experienced an anaphylactic shock. The patient had drug allergy histories to computed tomography contrast agents and injectable drugs as well as repeated contact dermatitis histories to topical agents. A month later, the patient came to the outpatient clinic. As a result, intradermal test for perioperative drugs, Mucosten, and Dexamethasone (Daewon Pharm) were positive. In addition, the 48-hour delay test for Mucosten and Dexamethasone was also positive. Under the suspicion of additive hypersensitivity, skin prick test was performed for disodium acetate, an additive containing Mucosten and Dexamethasone, which showed a positive result. However, skin prick test for N-Acetyl-L-cysteine, a main compound of Mucosten, was negative. This case is a hypersensitivity reaction to EDTA, which was confirmed by drug skin tests. In addition, this case is meaningful in that immediate and delayed hypersensitivity reactions to a single excipient appeared independently in the same patient.